[CPAP] Much higher AHI with a full face mask

[Sleeprider]

Related to my last post, here is the graduate course in CPAP and BPAP therapy principles.

[Gideon]

Nice Thanks
Sleeprider

[vas2000]

Thanks, Sleeprider. I dropped PS to 3 and increased min EPAP to 6 and max IPAP to 11 and even though the leakage was a bit worse, the AHI did come down further. It seems like the increase leakage coincided with an increase in pressure. Should I think about increasing max IPAP further?

BTW, your rather cogent explanation about the relationship between EPAP/IPAP/PS to obstruction, ventilation, CA, OA mostly flew over my head :-)! Is there a good book or a document that explains these fundamentals? I'd love to understand it all a bit better!

Thanks in advance!

[Sleeprider]

This looks great! I don't have any problems with taking IPAP max to 12, but controlling the leaks is a higher priority.

[vas2000]

Thanks for the video, Sleeprider.

I bumped up the IPAP to 12, did a bit more strap tightening and the charts look good with an AHI of 0.28! Thanks for everyone's help!

Do you think any further tweaking is warranted?

[Beej]

Looks really good to me. There are very few events, spaced throughout the night.

[vas2000]

BTW, is this leak rate acceptable - average of 5.99L/min, median of 4.8L/min with essentially no large leaks? Realistically, I am not sure that with the current Dreamwear mask (which I like a lot) that I can reduce it any further!

[Sleeprider]

Looks perfect. Also, you should understand that there will be higher rates of events on many nights, but you're dialed in. Keep it. You main problem early on was EPAP too low and too much pressure support. In theory you should be able to increase IPAP and the machine will only use what is needed for obstruction. I rarely hit my IPAP max. Good job on controlling leaks. Your original graph was really a sight, and you've come a long way!

[vas2000]

It's been an interesting week. I worked on sorting through the leaks on my Dreamwear mask. I made some decent progress and this chart for Thursday night seems to be pretty good from a numbers perspective:



The problem was that despite the good numbers and apparently a reasonable number of hours of sleep, I felt sleepy and lousy throughout the day on Friday (as bad as a typical day before I started my CPAP therapy) which left me pretty puzzled.

For last night, I decided to go back to the AmaraView FFM, bumped up EPAP by 1 cm (to 7.0), slept on my side on a high pillow. I've had a stiff neck for the past few days and the high pillow was causing neck issues so at around 5:20 am, I switched back to the Dreamwear nasal pillow. Here's the chart for it:



In general, the AHI with the FFM was a lot better last night (1.72) than the previous time (the chart in Sleeprider's last post where the AHI was 18.57!). Most of the events with the FFM seem to be Hypopneas. Any suggestions on changes to reduce/eliminate those would be appreciated.

I noticed that the IPAP was a lot closer to the max (12.0) with the FFM than with the Dreamwear. Should I increase the max IPAP or the min EPAP any further?

Thanks in advance!

[Sleeprider]

With a full face mask, it would not be out of line to increase pressures 0.6-1.0, but your event rate under 2 is not a big problem, and the important thing is to look after your comfort. Your images are way too small to be useful. Not sure what you did, but they are only 320 x 400. It looks like the night with the lower AHI (Friday?) had a lot of mask leaks, so that would explain your sleep disruption.